I’ll never forget the dentist appointment I had when I was 18. It was supposed to be a routine cleaning, the kind of thing you do every six months without a second thought. After my teeth were polished, the dental assistant took me to get X-rays. As I sat in the chair, I couldn’t help feeling nervous. I’d had plenty of cavities before, and I knew what I’d be in for if I needed more fillings. I asked the assistant if everything looked ok. He glanced at the images on the screen and shrugged. “I don’t see anything troubling,” he told me reassuringly.

A few minutes later, the dentist came in. He peered at the X-rays, did a quick exam, and then delivered the verdict: I had 19 cavities. I didn’t even know it was possible to have that many cavities at once without your teeth crumbling out of your mouth. I sat there in stunned silence, feeling as though the floor had dropped out from under me. When the dentist left the room, I turned to the assistant. How could he have missed 19 cavities? How could I have that much tooth decay without any pain at all?

He didn’t hesitate. He looked me straight in the eye and said, “You have Medicaid. That’s a dollar sign on your forehead.”

That sentence has stuck with me ever since. In that moment, it explained exactly why so many Medicaid patients receive such subpar care. I walked out of that office and never went back. However, the reality was that I didn’t have many options. Despite living in the middle of New York City, where you can find a dozen Thai restaurants on every block, I found it nearly impossible to find a dentist who accepted Medicaid and wasn’t running some racket. When I searched for reviews of the practices that did take Medicaid, they were flooded with one-star horror stories: botched procedures, rude staff, endless upselling, and billing scams. It felt like the only dentists willing to participate were those who had graduated last in their class or kept their doors open by defrauding the system, such as the one I had just seen.

I was so put off that I didn’t see a dentist again for three years until I finally got a job with private insurance. When I finally did go back, bracing myself for the inevitable discovery of those 19 cavities, something miraculous happened: They were gone. The new dentist reviewed my X-rays and........

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